PLEURAL FLUID CHARACTERISTICS IN HANTAVIRUS PULMONARY SYNDROME

Hantavirus pulmonary syndrome (HPS), is a rodent-borne, acute, often f ulminant cardiorespiratory illness, Noncardiogenic pulmonary edema is prominent in HPS as is cardiac dysfunction. Pleural effusions are comm only noted in patients with HPS and have been thought to be exudative. This report describes the prevalence and characteristics of pleural e ffusions by an assessment of chest radiographs for the presence of ple ural fluid and reviews all pleural fluid specimens obtained from patie nts with HPS. Of 23 patients treated at the University of New Mexico H ospital for HPS, 22 had evidence of pleural fluid while 4 had sampling of their pleural fluid, Two samples met criteria for an exudate by pl eural fluid protein to serum protein ratio of more than 0.5; one was c learly a transudate and the other had inconsistent characteristics, Th e two exudative samples were obtained 7 days after admission, while th e other 2 were obtained within 1 day of admission, Pleural fluid cultu res were sterile, and the total of nucleated cells was less than 170/m m(3), and predominately mononuclear. A hypothesis may be formulated th at the pleural fluid in HPS is initially transudative, consistent with the observed cardiopulmonary dysfunction, However following aggressiv e resuscitative efforts and as the acute illness resolves, fluid shift s occur as cardiac function normalizes; the pleural fluid may take on characteristics of an exudate.